Vascular endothelial growth factor in neonates with perinatal asphyxia.
BACKGROUND
Vascular endothelial growth factor (VEGF) is a polypeptide growth factor that is activated by tissue hypoxia. The role of VEGF in perinatal asphyxia in human neonates is yet to be clarified. In infants who develop moderate to severe acute hypoxic ischemic encephalopathy (HIE) it is crucial to clearly understand physiologic and biochemical changes that accompany HIE before a novel treatment can be developed.


OBJECTIVE
To assess VEGF in cord blood of infants suffering from perinatal asphyxia, and to determine whether an association exists between increased concentrations of VEGF and the risk for development of encephalopathy.


METHODS
We prospectively studied 40 full term infants; of them 20 infants suffered from perinatal asphyxia, and 20 control infants of comparable age and sex. We obtained cord blood samples from all subjects immediately after delivery. Neurological examination and grading of HIE were performed during the first day of life.


RESULTS
Birth weight, gestational age and gender did not differ between the control (n=20) and asphyxia (n=20) groups. Within the asphyxia group four infants developed HIE; one with severe encephalopathy who died shortly after birth, while the other three infants had moderate HIE. Concentrations of VEGF were increased in infants with asphyxia when compared to controls (P0.001). Within the asphyxia group, infants with HIE had significantly increased concentrations of VEGF when compared to non-HIE asphyxiated infants (P=0.008). In the logistic regression model, VEGF inversely correlated with pH and PO(2) in cord blood, and Apgar scores at 1min, while it did not associate with gestational age and birth weight.


CONCLUSIONS
This study indicates that VEGF is increased in cord blood of neonates following birth asphyxia, and that VEGF is specifically most increased in infants who later developed encephalopathy. Further studies are required to determine the role of VEGF in brain insult. Such studies will help determine whether a therapeutic role for VEGF or VEGF inhibitors can exist for HIE infants.
Aly
Hany
H
Department of Newborn Services, George Washington University and Children's National Medical Center, Washington, DC 20037, USA. haly@mfa.gwu.edu
Hassanein
Sahar
S
Nada
Ayman
A
Mohamed
Maha H
MH
Atef
Shereen H
SH
Atiea
Wael
W
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000097:blood* / Q000150:complications; D036861:Delivery, Obstetric; D005260:Female; D005312:Fetal Blood; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000097:blood / Q000209:etiology; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D012720:Severity of Illness Index; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A